Khera Pooja, Haught Justin M, McSorley John, English Joseph C
Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
J Am Acad Dermatol. 2009 Mar;60(3):484-6. doi: 10.1016/j.jaad.2008.08.047. Epub 2008 Nov 20.
The characteristic presentation of herpesvirus infections is a vesicular rash. The initial lesions appear as erythematous papules that turn into grouped vesicles and pustules eventuating into crusts. In most cases, the features are so characteristic that a diagnosis can be made by history and physical examination without further diagnostic testing. However, patients who are immunosuppressed (including those with hematologic malignancies) often have atypical presentations of herpesvirus infections. These cases require a high index of suspicion and appropriate diagnostic testing for proper management. In this report, we describe two patients with chronic lymphocytic leukemia who developed atypical presentations of herpes zoster and herpes simplex infections. Herpetic infections should always be in the differential diagnosis of cutaneous ulcerations with necrosis in patients who are immunocompromised. Because of the atypical appearance of the lesions, the diagnosis may be confused or mistaken for several other conditions.
疱疹病毒感染的典型表现是水疱性皮疹。最初的皮损表现为红斑丘疹，随后发展为成簇的水疱和脓疱，最终形成痂皮。在大多数情况下，这些特征非常典型，仅凭病史和体格检查即可诊断，无需进一步的诊断性检查。然而，免疫抑制患者（包括血液系统恶性肿瘤患者）的疱疹病毒感染通常表现不典型。这些病例需要高度怀疑，并进行适当的诊断性检查以进行妥善管理。在本报告中，我们描述了两名慢性淋巴细胞白血病患者，他们出现了带状疱疹和单纯疱疹感染的非典型表现。对于免疫功能低下且有皮肤溃疡伴坏死的患者，疱疹感染始终应列入鉴别诊断范围。由于皮损外观不典型，诊断可能会与其他几种疾病混淆或误诊。
